Lurie Jon D, Birkmeyer Nancy J, Weinstein James N
Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire, USA.
Spine (Phila Pa 1976). 2003 Mar 15;28(6):616-20. doi: 10.1097/01.BRS.0000049927.37696.DC.
Small area analysis.
To determine the association between the rates of advanced spinal imaging and spine surgery across geographic areas.
The rates of spine surgery in the United States have increased along with a concurrent rise in the use of advanced spinal imaging: CT and MRI. Spine surgery rates vary six-fold across geographic areas of the United States. Differences in patient populations and health care supply have explained only about 10% of this variation.
We used a random 5% sample of Medicare's National Claims History Part B files for 1996 and 1997 to determine procedure rates across 306 Hospital Referral Regions. We analyzed the association between spinal imaging and spine surgery using linear regression. Main outcome measures were rates of procedures and coefficients of determination (R2).
The rates of advanced spinal imaging (CT and MRI combined) varied 5.5-fold across geographic areas. Areas with higher rates of MRI had higher rates of spine surgery overall (r = 0.46) and spinal stenosis surgery specifically (r = 0.37). The rates of advanced spinal imaging accounted for 22% of the variability in overall spine surgery rates (R2 = 0.22, P < 0.001) and 14% of the variability in lumbar stenosis surgery rates (R2 = 0.14, P < 0.001). A simulation model showed that MRIs obtained in the patients undergoing surgery accounted for only a small part of the correlation between MRI and total spine surgery rates.
A significant proportion of the variation in rates of spine surgery can be explained by differences in the rates of advanced spinal imaging. The indications for advanced spinal imaging are not firmly agreed on, and the appropriateness of many of these imaging studies has been questioned. Improved consensus on the use and interpretation of advanced spinal imaging studies could have an important effect on variation in spine surgery rates.
小区域分析。
确定不同地理区域的脊柱高级成像率与脊柱手术率之间的关联。
美国脊柱手术率随着脊柱高级成像（CT和MRI）使用的同时增加而上升。美国不同地理区域的脊柱手术率相差6倍。患者人群和医疗保健供应的差异仅解释了这种差异的约10%。
我们使用了1996年和1997年医疗保险国家索赔历史B部分文件的5%随机样本，以确定306个医院转诊区域的手术率。我们使用线性回归分析脊柱成像与脊柱手术之间的关联。主要结局指标为手术率和决定系数（R2）。
脊柱高级成像（CT和MRI合并）率在不同地理区域相差5.5倍。MRI率较高的地区总体脊柱手术率较高（r = 0.46），特别是脊柱狭窄手术率较高（r = 0.37）。脊柱高级成像率占总体脊柱手术率变异性的22%（R2 = 0.22，P < 0.001），占腰椎狭窄手术率变异性的14%（R2 = 0.14，P < 0.001）。一个模拟模型显示，手术患者中进行的MRI仅占MRI与总脊柱手术率之间相关性的一小部分。
脊柱手术率差异的很大一部分可以由脊柱高级成像率的差异来解释。对于脊柱高级成像的适应证尚未达成坚定共识，许多这些成像研究的适当性也受到质疑。改善对脊柱高级成像研究的使用和解读的共识可能对脊柱手术率的差异产生重要影响。
